Margaret Court Limited

Margaret Court is registered to provide personal care to older people. Care and support was provided to people at prearranged times in a specialist ‘independent living’ service. Margaret Court consists of 44 apartments and six bungalows. People living at Margaret Court own their own home and share on site communal facilities such as a passenger lift, lounges, dining room and the use of an onsite restaurant.

This provider is based at Margaret Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living at Margaret Court receives regulated personal care. At the time of this inspection visit, Margaret Court staff supported four people, so we only looked at the care and support for those four people receiving personal care from this provider.

People's experience of using this service and what we found

Systems to learn lessons when things went wrong continued to need improvements.

Audits or checks we would expect to be completed for this type of service, such as medicines, care call logs, daily record checks were not always completed or completed regularly. The systems were not effective and in addition, there was no oversight when checks were delegated to others. There was no evidence the provider undertook any quality assurance checks. The provider had not shared important learnt lessons from other inspections where shortfalls had been identified. At this inspection, similar issues around a lack of effective systems remained as found at the last two inspections.

People’s plans of care guided staff to provide safe care. Staff’s knowledge of how to support people was consistent with what people told us. However, people’s risk assessments required more information to help staff provide consistent support to manage those identified risks. The registered manager assured us this would be addressed. Conversations with staff showed they knew how to manage risk. In some examples, intervention by a GP or occupational therapist had been sought to help keep people safe.

People were complimentary about the service they received. Staff and the provider knew how to keep people safe and protected from abusive practice.

People said staff were kind, caring, gentle and in the majority of cases, always willing to do what was needed. People were cared for by staff who attended training relevant to their roles.

Staff followed infection control procedures in line with national guidance for reducing the spread of COVID-19 when supporting people with personal care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff training was completed and staff said the training they had, helped them to support people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Good (published 13 September 2019)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Margaret Court Limited is a domiciliary care agency that provides personal care to older people who are living in their own homes. Margaret Court consists of 44 apartments and six bungalows. Care and support is provided to people at prearranged times in a specialist 'extra care' housing setting.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. At Margaret Court, each person exclusively owns their own home and the building is designed to enable and facilitate the delivery of care and housing related support to people now, or in the future.

The provider is based at Margaret Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living in extra care housing receives regulated personal care. At the time of our inspection visit, two people living at Margaret Court received personal care from Margaret Court Limited. Therefore, for this inspection, we only looked at the care and support for those two people receiving personal care from this provider.

People’s experience of using this service and what we found

Safeguarding systems and processes were in place to protect people from avoidable harm. Staff understood their responsibilities and knew what to do if they had any concerns about a person’s welfare. Staff understood their responsibility to follow good infection control practices. A relative confirmed staff minimised the spread of infection by wearing personal protective equipment.

Risks to people’s health and well-being had been identified. However, it was not always clear how the level of risk had been identified and instructions for staff on how to mitigate risks lacked detail. This meant staff may not carry out all necessary actions to minimise risks to people’s safety. However, staff confirmed they knew how to minimise risks to people’s health and wellbeing and action was being taken to improve records to support this.

At the time of our inspection, the people receiving support with their personal care, did not require support to take daily medicines. However, support was required to apply topical creams or administer ‘as and when’ medicines. Improvements had been made and guidance was now recorded in people’s care plans to ensure medicines were administered safely and consistently.

The recruitment process checked employees were suitable for working with vulnerable people. However, we found one example where the provider had not carried out all required pre-employment checks. This had already been identified and appropriate action had been taken to mitigate this risk. People received their care calls at the time they wanted, and staff were always on time. An emergency 24-hour support service was provided for people to use outside of their care calls where needed.

People's needs, wishes and preferences had been assessed before they received support from the service. People had enough to eat and drink. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

A relative told us staff were caring and kind and treated people with dignity and respect. The service had been flexible and responsive to meet people’s needs. Although some improvements were required with mandatory training, staff and a relative felt staff had the skills required to meet people's individual needs.

Some improvements had been made and systems and processes were now in place to assess, monitor and improve the quality and safety of the service. However, these checks had only recently been implemented and had not been in place long enough for us to assess whether they were effective in driving improvement within the service.

Although the issues found during our inspection had been identified, action had not always been taken to make the required improvements. For example, risk assessments lacked detail, personal emergency evacuation plans were not in place and mandatory training had not always been refreshed in line with the providers expectations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 07 September 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we some found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has improved and is now rated as good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link Margaret Court Limited on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Margaret Court is registered to provide personal care to older people. Care and support was provided to people at prearranged times in a specialist ‘extra care’ housing service. Margaret Court consists of 44 apartments and six bungalows. People living at Margaret Court share on site facilities such as a lift, lounge, library, dining room, laundry and a garden.

Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. At Margaret Court, each person exclusively owns their own home and the building is designed to enable and facilitate the delivery of care and housing related support to people now, or in the future. The provider is based at Margaret Court and provides emergency support to everyone living there. Planned day to day personal care can be provided by staff based at this site or from other agencies who provide personal care and support packages. Not everyone living in extra care housing receives regulated personal care.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection only looked at people’s personal care service provided by Margaret Court.

At the time of this inspection visit, Margaret Court staff supported six people in six apartments. Therefore, for this inspection, we only looked at the care and support for those six people receiving personal care from this provider. All six people continued to be independent and did not have any complex care needs.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we rated the service Good overall, however at this inspection we found some aspects of the management of the service required improving so the overall rating has changed to Requires Improvement. In ‘Well led’ we found a lack of evidence and embedded practices that had not identified some of the concerns we found that has resulted in one breach of the regulations. We found evidence in ‘Safe’ that had potential to place people at unnecessary risk. Where risks associated with people's health and wellbeing were known, there was no information to tell staff how to manage those risks. Some risks for particular health conditions were not included within care plans and staff’s practice of administering medicines was not in line with NICE guidance, which had potential for staff not to provide consistent support.

People were pleased and satisfied with the quality of care provided by a consistent, kind and caring staff team. People and relatives were complimentary of the service and staff and people said there were enough staff to provide them with the care and support they needed, at the times they preferred.

People were supported to remain as independent as possible so they could live their lives as they wanted. People made day to day choices about what they wanted to do for themselves and how they lived their lives. People were encouraged to maintain important relationships with family and people built friendships with others living at Margaret Court.

Care plans were not person centred and did not contain all of the information required for staff to provide consistent and safe care. For people assessed as being at risk, care records did not include important information for staff to help minimise risk. When people’s needs changed over time, there was no updated care plan or process to ensure staff delivered care in line with those changing needs which meant there was an inconsistent approach in how staff supported those individuals.

Staff knew how to keep people safe from the risk of abuse. Staff and management understood what actions they needed to take if they had any concerns for people's wellbeing or safety. People told us they felt safe living at Margaret Court and felt relaxed when staff provided their support.

Care staff did not always receive sufficient training to effectively meet and support people’s health conditions and the lack of effective management of training meant refresher or essential training was not completed within the provider’s expected timescales.

Staff worked within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where ‘s capacity was fluctuating, staff’s knowledge ensured people received consistent support so the right decisions and outcomes were made. Care records needed better documentation to show what decisions people had limited capacity and understanding to make. Staff told us they sought people’s consent before they provided care and support and recognised this was an important part of their role in promoting choice and independence.

People received support from other healthcare professionals and relatives told us they were notified whenever changes in their relative’s condition had happened, and health professionals were referred to for advice and treatment.

Some people took responsibility for their own medicines management while staff supported others. For those who needed staff support, there was no effective management to show medicines were stored safely, and given as prescribed.

The registered manager could not provide us with any examples of completed audits and checks that gave them and the provider confidence people received a safe, responsive and effective service. We asked to look at audits for incident and accidents, analysis of falls, care plan audits, complaints, medicines and survey questionnaires to see how actions had been taken to drive improvements. However, these records were not completed so we could not be confident, actions would be taken to make improvements to the service people received.

Further information is in the detailed findings below.

Margaret Court provides a home care agency service including personal care for up to 50 people who own their own homes within the complex. Margaret Court has three floors with 44 apartments. There are also six bungalows in the grounds. There are communal facilities available which include a lounge area, a dining room, a library and a garden. At the time of our visit there were two people receiving personal care from the Margaret Court staff. The amount of care and support varies from a few hours domestic support each week, to people receiving support up to 24 hours a day. Some people purchased care and support from Margaret Court and others purchased this care and support from other external home care agencies.

Margaret Court had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe. Staff were confident to report any concerns and were aware of their responsibilities to keep people safe from harm. Staff had been recruited following safe recruitment procedures. People were kept safe through risks being identified and well managed. People received support receiving their medicines as prescribed.

People received care and support from staff who had received training to meet their individual needs. Staff were given opportunities to meet regularly with their seniors to reflect on their practice and continually improve their performance. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and staff promoted and respected peoples’ choices and decisions. People were supported to receive the healthcare services they required.

People received care and support from caring and kind staff and were treated with respect and dignity. Staff were compassionate towards people and assisted people to retain their independence and make their own decisions about their life style choices.

Peoples’ individual needs were at the centre of the service offered and provided. Staff responded to peoples’ changing needs. People were encouraged to express their views about the service and where suggestions for improvements were made, staff acted on these to improve the quality of services delivered.

The registered manager and senior team were well respected, were accessible and provided effective leadership. The vision and values of the service were clearly communicated to and understood by staff. Systems to monitor the quality of the service were in place and used to inform decisions in order to make improvements where required.

People who lived at Margaret Court told us, 'Could not find a better place.'

We saw staff were kind and attentive when speaking with people. We saw people were supported and encouraged to maintain their independence.

We looked at two people's care records and saw their care plans reflected their personal needs.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. We saw staff had a formal meeting with the manager.

We found the service had systems in place to monitor the quality of service provided at Margaret Court.

We saw people's needs had been assessed, risks identified and personalised plans of care developed for each person. We saw evidence of involvement of allied professionals to ensure people's ongoing healthcare needs were met.

The staff confirmed staff recruitment processes were robust and as such ensured people were cared for by staff that had the appropriate skills and experience. We observed recruitment processes had been robust.